Perpetuating the Prostitution Pledge: Allegiance to Failure

In yet another example of the Bush Administration’s assault
on public health and human rights using the unwieldy club of "morality," it
appears that the prostitution pledge will remain embedded in the forehead of U.S.
global AIDS policy for several years, unless advocates can muster enough
support to pluck it out.

Common sense, respect for human rights, and the urgency of
HIV prevention all cry out for an end to the pledge, which requires
organizations receiving U.S.
global AIDS funds to have a policy explicitly opposing the practice of prostitution. This policy must apply to all the organization’s activities – even
those funded by other donors.

The Center for Health and Gender Equity (CHANGE) just
released our policy brief that highlights the many legal, ethical, and
practical alarm bells raised by the pledge.
Based largely on interviews with people on the frontlines of HIV
prevention among sex workers, the brief looks at the pledge’s impact on
life-saving programs on the ground.

What it reveals is a dismal picture: effective programs
suddenly cut off from funding, groups self-censoring messages on sex worker
rights, and sex workers with nowhere to go for support or condom supplies.

The good news is that for many U.S.-based organizations, the
pledge no longer applies. It occurred to
some people, including judges in two district courts, that compelling U.S.
organizations to spout the government line with money they raise from other
sources runs into a little problem called the First Amendment. The Administration is still trying to do an
end run around the rulings, but advocates hope that the pledge will soon be
history for the large collection of U.S. plaintiffs. (For more on court
rulings against the pledge, visit this page.)

But that won’t help international organizations overseas.

People who work in these organizations say (and evidence
confirms) the most effective HIV
prevention programs for sex workers develop trust, affirm dignity and create
unity. You can’t reach sex workers if
they think you might report them to the police, or if they think you’re judging
them. You can’t convince sex workers
that they should use condoms if they believe their lives aren’t worth
saving. No sex worker will enforce
condom use with her clients if she thinks everyone else will get more business
by not enforcing condom use.

But our report
found that the best programs at creating trust, dignity and unity are exactly
those most at risk under the pledge.

In Bangladesh, for
example, a sex worker outreach program lost money when the international
organization that funded them signed the prostitution pledge. Their drop-in centers – safe spaces for sex
workers to gather and access health services – were cut from twenty centers to
just four, despite international recognition for their success. For sex workers there, most of whom are
homeless, the loss of drop-in centers meant losing the place where they slept,
bathed, educated themselves, and – perhaps most importantly – received condoms.

A big part of the
problem is that the policy seems deliberately vague. The Administration refuses to define what
"promoting the practice of prostitution" means in terms of specific activities,
although it retains the right to investigate all the activities of funding
recipients to make sure they oppose prostitution enough.

As the report
finds, the resulting confusion in the field has created a climate of fear and
silence, paralyzing organizations that sign the pledge. We found groups clearing their websites of
any mention of sex worker rights, groups avoiding media coverage for fear of
drawing attention to their work, and groups no longer engaging sex workers in
their HIV prevention efforts because it’s simply not worth the heightened scrutiny.

These
organizations always have to second guess themselves: If they empower sex workers to become peer
educators on negotiating condom use with clients, is that promoting
prostitution? Is teaching them English so they can better communicate with
clients promoting prostitution? If a
group organizes sex workers to collectively enforce condom use with clients,
and the sex workers start talking about their right to be sex workers, does
that group have to give back its money?

So rather than
unity, trust and dignity, the pledge has promoted confusion, isolation and
shame. By causing organizations to
eliminate, water down, or censor their prevention efforts with sex workers, the
pledge has undermined evidence-based best practices in public health.

And the really
sad part is this: there is no upside. The
pledge has had absolutely no measurable impact on decreasing prostitution. Incredibly, that’s what the Bush
Administration says is the purpose of this policy – to reduce HIV transmission
by ending the practice of prostitution.

Does anyone out
there think forcing nongovernmental groups to have a policy against
prostitution has any bearing at all on how many human beings around the world
have sex for money? Really?

So that’s what
U.S. taxpayers get for their millions in HIV prevention money: a policy that
has no discernible impact on its stated goal, yet causes the best programs to either
contort or silence themselves to fit a particular conservative worldview, or risk
closure by shunning U.S. money.

Let’s hope – no, let’s make sure – the next Congress and Administration do better.

Thank you for this accurate summary of the effects of the anti-prostitution pledge in PEPFAR. I have waited to see CHANGE’s report and while I’m disappointed about PEPFAR I’m very glad that this research was undertaken. It is tragic that there is no silver lining to the restrictions imposed by PEPFAR, and shameful that the US has chosen to perpetuate this. Taking the Pledge is a short video that offers more information about the effects of the anti-prostitution pledge.

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Thank you for the research, yes indeed i was working with sex workers at HIllbrow Johannesburg providing an out reach clinic and health education which had a huge impact on the lives of these vulnerable women. The sudden change in funding Policy affected the way the program was running and adversely affected sex workers themselves as they relied on these services. I would suggest that the policy need to be reviewed in order to be successful in reducing the incidence rate of HIV.